“But if at the national level they decide to throw the baby out with the bath water, I think that would be disastrous,” said Lepore-Jentlesen, executive director of East End Community Services, a Dayton non-profit in the fight to rid the community of heroin and help those addicted with treatment.
Medicaid, the national health care program for those with disabilities or low income, pays for a vast majority of drug treatment programs — from detox to medication-assisted treatments like methadone and Suboxone and counseling. It is part of Obamacare, which Trump and national Republicans have vowed to dismantle.
Gov. John Kasich countered the wishes of Statehouse Republicans when he pushed ahead with Medicaid expansion in Ohio, which went into effect on Jan. 1, 2014. Some members of the Community Overdose Action Team — the group studying how to reduce local overdose deaths — met with members of Kasich’s cabinet in Dayton two weeks ago.
“They really wanted to understand how we are approaching this as a public health crisis and emergency epidemic,” said Montgomery County Commission Dan Foley. “It was a good meeting. We felt encouraged by the fact we are approaching it the right way. By no means did we say that we have had success yet because it’s like the first inning of a baseball game.”
About 5,000 Montgomery County Alcohol Drug Addiction & Mental Health Services (ADAMHS) clients were enrolled via Medicaid expansion in 2015, according to an ADAMHS spokeswoman. In Ohio, Medicaid expansion covered 676,850 Ohioans as of June 2016. Since the beginning of the program, 954,887 non-duplicated individuals have received coverage. Within that group, approximately 50 percent had a Medicaid claim for behavioral health services, which includes substance abuse, according to the Ohio Department of Medicaid.
Trump said Obamacare has resulted in runaway costs, clunky websites, rationing of care, and fewer choices. His campaign website says, “On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.”
Since the election, Trump has made comments that seem to favor keeping some elements of the ACA, like not being denied coverage for a pre-existing condition and the ability to stay on a parent’s plan until age 26.
Jeff Cooper, Montgomery County health commissioner, wouldn’t speculate on what will happen with the new president and Congress, but he wants the current law left alone when it comes to providing treatment options for drug users.
“We would hope those provisions stay in place as we move forward with the new administration,” Cooper said. “If changes occur, then we need to be resilient enough as a community to figure out how we are going to continue this process to move forward.”
Terry Jones, CareSource director of behavioral health for Ohio, said access to care is already a problem and doing away with existing law would inevitably hurt users more. CareSource is a Medicaid provider that also sells insurance on the health care exchange.
In January, Ohio will begin reimbursing for even more addiction services like the administrative costs of naloxone, the opioid overdose antidote, and other treatments, Jones said.
“If they did away with expansion, then those individuals currently receiving treatment through the ACA would no longer be eligible for treatment,” he said. “Therein lies the impact. Certainly it’s our hope that doesn’t happen.”
Overdose deaths are now calculated at 181 for the first half of 2016, fewer than an earlier preliminary report, Cooper said.
“We want to see that number stabilize and the ultimately decrease,” he said. “The only way to do that is to have a common framework and plan.”
Dayton Police Chief Richard Biehl said emergency calls related to opioid overdoses have slowed in the year’s second half. But the number through June is large enough to anticipate deaths will still exceed the record high of 264 overdoses in 2014 and last year’s 259.
A steering committee for the Community Overdose Action Team Monday laid out its next steps. The plan includes seven branches: prevention, supply, treatment and recovery, prescription opioids, education, response, and programs like naloxone distribution and needle exchanges.
Within the next month, groups will be meeting to identify gaps and overlaps in services.
“We’re going to improve our communications as a system. And we’re ultimately going to be very purposeful in how we move forward to address the various components of improving the unintentional drug overdose death rates in this community,” Cooper said.
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